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Tuesday, 21 October 2014

Differences in being left hand
dominated and right hand dominated can be a starting point in evaluating cerebral
dominance, behavioral-cerebral correlations and inter and intra-hemispheric meshing.
The neuron system in patients with neuro psychiatric disorders is responsive in
differing pathways depending on handedness, clearly seen in brain saliencing
networks when given the same behavioral tasks. If we can trace handedness related
neural pathway variations, it is one way
drugs can be more precisely prescribed for the millions of sufferers who are
not experiencing effective relief from symptoms.

A second way to map the fundamental cause of brain disease
is to take the theory that neural stem cells mature certain brain cells too
early and this early maturity is triggered by extreme stress at a crucial
moment in adolescent brain development. This
then affects how those cells are merged in the cellular network and may cause blocks. In
order to put this theory into practice, we can follow a sample group of
adolescents with mental health disorders of any kind in their immediate family in
a “diary plus brain map” experiment to establish data that could be used to taxonomize prevailing
factors and exact times where young adults and brain development are most
vulnerable.

Tuesday, 12 August 2014

The latter part of adolescent brain development is of particular interest to mental health care research, because the time window corresponds to the age of onset
of most major neuropsychiatric disorders, especially schizophrenia. A
striking feature is the similarity between
genes and processes altered during late adolescence and those known to
be dysfunctional in the schizophrenia brain. For example, the leading
candidate risk factor gene, NRG1.which has also been linked to bipolar disorder is minimally expressed during late adolescence together with its ligand ERBB4. This result is supported by salience network analysis of prefrontal cortex changes.

borrowed image: disclaimer.

Due
to the strong evidence for white matter alterations during adolescent
brain development, and evidence for the involvement of aberrant
myelination in major neuro-psychiatric disorders, it can be predicted that genes
related to myelination would be detected in this analysis.

It has often been been debated whether the decrease in grey matter
volume in the adolescent prefrontal cortex found in brain imaging
studies is a true reflection of synaptic loss or in fact an artefactual
representation of increased white matter volume. There is evidence at the gene expression level that there are alterations in processes associated with synaptic development
during adolescence, in addition to increased expression of myelination
genes. Genes associated with energy generation via
glycolysis and oxidative phosphorylation reach peak expression during
adolescence, coupled with other active cellular processes such as
transcription, translation and protein transport. This may represent an
increase in energy supply to the prefrontal cortex. There is a peak in resting cortical glucose utilisation in early adolescence
with a gradual decline to reach adult values in late adolescence.

Bi-polar or schizophrenia
Previous hypotheses have focused on the role of neuregulin in
early development as a predisposing factor to schizophrenia, the present
data suggest that it has an important additional function in the
maturation of the prefrontal cortex and may be one of the factors
involved in specific mutation and development at this time point.

Neurotransmitter
systems that show altered function during adolescence may also be
particularly vulnerable to perturbation during this period; results
suggest that neuropeptide and glutamate signalling may be particularly
important. There is strong evidence that glutamatergic abnormalities are seen in
schizophrenia and bi-polar, possibly due to the psychosis-inducing effects of
glutamate antagonists such as PCP.

Alterations in neuropeptides in neuropsychiatric create disorders and
the alteration in expression of these genes during this critical
developmental period, in a region of the brain strongly associated with
schizophrenia symptoms, (in particular auditory hallucinations) strengthens the evidence for their role in the
etiology of schizophrenia.

It should be noted that the exact development of these gene expressions are directly connected to the timing and peaking of contributing stress factors of which the neurotransmitter systems are the key monitors of. My theory is that both bi-polar and SZ are strongly and closely linked and the exact mutation moments are critical in confirmation of which will develop. With farther and extensive brain salience networking analysis of early-late adolescent brain development especially in traumatized young adults, we can I believe begin an earlier diagnosis of both disorders.

In answer to areas of doubt that surface in the ongoing
claim that ‘hikikomori’ is a culture bound

syndrome, this paper looks very briefly but closely at five
important differences in the symptomatic

manifestations that are different in social withdrawal in
both Japan and other countries; and in doing so

draws from the limited documented research available on
differences of not only symptom but also

societal attitude and treatment approach.

Introduction:

In this paper I would like to define and further address five
of the key points that arose from question

and answer session at the international IAFOR Psychiatry and
Behavioral Science Conference in Osaka

this March. I
presented the opinion that hikikomori is a Japanese culture bound symptom and

disorder at the conference and had the fortune to speak with
many clinical psychiatrists from New

Zealand, Australia, Taiwan, India, UK, Korea, and USA afterwards regarding the claim. In doing so I

narrowed down the five areas that I believe are key in identifying hikikomori as a specifically
culture

bound phenomena, in
other words a Japanese specific psychiatric symptom.

1.The confusion and definitive boundary definition
lines of hikikomori and agoraphobia or
acute social withdrawal which are
synonymously used as other definitive descriptions of hikikomori in the US and
UK.

2.The fact that 80% of hikikomori sufferers in
Japan only, are male.

3.The specific connection that Japanese hikikomori
has with prior school truancy V the
very low percentage of this being a trigger factor in other countries.

5.The absence of key symptoms such as panic and lack of social stigma that are present in social withdrawal and agoraphobia
as defined in Western Psychiatry but not in hikikomori.

Key difference #1.

William Foreman from Michigan in USA( 2012:3 ) writes:

Hikikomori overlaps with several Western mental health diagnoses including
pervasive developmental disorders, avoidant personality disorder, PTSD and
other anxiety disorders. I will outline some of the comparisons to agoraphobia
and social phobia.

Hikikomori is similar in many respects
to severe agoraphobia. While many people with agoraphobia are afraid only of specific clusters of activity such as
driving or attending crowded events, others are afraid to leave home at all.
Hikikomori is defined as a state of complete social withdrawal that lasts at
least three months in Korea or six months in Japan. In both disorders,
sufferers typically do not communicate with anyone outside the home.

A major difference between hikikomori
and agoraphobia is the age of onset.
Hikikomori is strictly a disorder of young adults. Those who were in the first
group to be diagnosed are, as of 2013, not yet 40 years old. To be initially
diagnosed, the sufferer must be no older than 30

This is just one of many clinical psychiatrist’s observations
that specific differences exist in the

actual semantic clarity of definitive status between hikikomori
and similar psychiatric symptoms

elsewhere. Foreman writes “overlaps
with” and I believe this is an accurate claim that clarifies

the uniquely cultural bound nature of hikikomori. There are too
many other examples to list here

but time and again in published definitions found in psychiatric
journals¹both social withdrawal

and agoraphobia are defined with elements or key components
missing when compared with the

Japanese definition of hikikomori²

While some of the non Japanese psychiatrists I have spoken with and mailed
with, have claimed to have seen

patients who are suffering from ‘hikikomori’, their interpretation
of the term does not include

some of the components I believe to be Japanese specific and
therefore, like the name itself

include; the extreme
reluctance of families to take part in behavioral therapy at initial onset-

where it is proven to be most effective;

the pressure on first borns and often male children to follow
one educational path toward

job fulfilment; the prevalence of truancy preceding hikikomori,
the history of Japanese mind set

“retreat/ignore” as a defense position; the unique social stigma
magnified by proximity of

neighbors in a small land space and many others.

Many psychiatrists from other countries that I spoke with
claimed that the treatment of what they felt

was hikikomori or its equivalent, necessitated a strong approach by bringing
the young adult out of his

room with force and into family group therapy urgently; interestingly the ways felt appropriate to
broach treatment and healing of hikikomori

symptoms also vary from country to country according to educational and child raising norms- meaning the ways
felt appropriate to treat hikikomori are

also culturally specific; in itself an indication that there
is little reason not to assume that the specific

definition and manifestation of hikikomori is also
culturally specific.

Key Difference #2

Dr. Saito Tamaki, who coined the term hikikomori back in 1998,
and with whom I had the great pleasure

of meeting in his Funabashi clinic in March 2014, claims in
his book ( ) that hikikomori is culture bound

due to the epic number (over one million) who have chosen to
stay in their rooms in an act of seeming

defiance against cultural expectations that do not exist in
the exact same way in other countries. This

was an area I felt to be one connected to the history and
language and social etiquette that is linked to

the unique culture of Japanese people. In a culture that is
so very different from Western culture, how

can we expect psychological disorders to be the same when………………………………………….()

Moreover, research that Dr. Saito conducted with patients
estimated 80% of hikikomori are male and

Of those 80%.................are first born male. As explained
in detail in my last paper in a male dominated

value index country (Hofstede : ) this fact alone could be enough to label
hikikomori as Japanese

culture bound given the pressure for Japanese males to get
work and stay in that same work and the

devotion above all to the company versus family. Conversely,
Western society has the similar symptoms

of “social withdrawal”
standing at equal part male versus female and “agoraphobia” being statistically

mainly female.

Quoting Foreman again (ibid):

Identified in 1998, it appears to be
culturally linked to changing labor market realities in Asia. Under the
traditional system, middle and upper-class youths follow a highly structured
path from adolescence to adulthood. They are expected to rigorously apply
themselves in high school and college, and then immediately take a professional
job. The job market has traditionally been secure, and the first employer out
of college is expected to be the company that the young adult will remain with
until retirement.

Increased globalization and changing
labor markets have made this ideal unattainable for many youth. Many
adolescents follow the expected path through college only to discover that they
are unable to find a job, or can only find one for which they are vastly
overqualified. For some young people, the realization that they did everything
right but cannot reap the benefits leads them to shut down. Hikikomori overlaps
with several Western mental health diagnoses including pervasive developmental
disorders, avoidant personality disorder, PTSD and other anxiety disorders..

Key Difference #3.

In the following diagram, it can be seen the main reasons
for “dropping out” of college in the US.

The validity of this diagram is to serve as a reminder that
ONLY 13% count “social misfit” or “Poor social

fit” as a factor for opting out, where in all surveys of
hikikomori I have yet to read this has been the

PRIMARY cause and trigger for hikikomori ( ). Not necessarily with truancy – usually caused
by bullying

or a feeling of misfit - but also from failing to adapt to expectations
within societal norms ( ).

Key Difference #4

In the following diagram we can see the extreme endurance
that families have in dealing with

hikikomori and the extreme length of time that sufferers will
retreat to their rooms for. Most commonly over 7 years and very often as long as 15 to 20 years.

When I have presented this slide to clinical psychiatrists,
they have found time and again, this to be one

of the most alarming and single handedly most clearly differentiating
factors in manifestation of social

withdrawal.

The average length of time as a one off comparison in the
USA for hikikomori or its sister name social

from societal pressure)
is considered to be approximately a few months to two years
( ).

Key Difference #5

I will now take a closer look at the very detailed exact
symptoms that are presented in the related

non Japanese
disorders that involve social withdrawal and appear on the surface most closely
mirroring

the outward appearance of hikikomori.

These are:

·Avoidant Personality Disorder

·Acute social Withdrawal

·Agorophobia

According to the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), a person diagnosed with avoidant personality disorder needs to show at least four of
the following criteria:

Avoids occupational activities that involve significant
interpersonal contact, because of fears of criticism, disapproval, or
rejection.

Is unwilling to get involved with people unless they
are certain of being liked.

Shows restraint within intimate relationships because
of the fear of being shamed or ridiculed.

Is preoccupied with being criticized or rejected in
social situations.

Is inhibited in new interpersonal situations because of
feelings of inadequacy.

Is unusually reluctant to take personal risks or to
engage in any new activities because they may prove embarrassing.

Hikikomori typically does not involve 4 of these criteria.
Many hikikomori people are for example in fact highly intelligent and do not feel
they are inferior to others. In fact some have feelings of ‘higher
intelligence or non main-stream intelligence” (Zeilinger: )They may or may not have a fear of being
disliked, it is certainly not a critical factor in defining hikikomori.
Hikikomori are NOT unusually reluctant to engage in new activities because they
may prove embarrassing or avoid personal risk – since statistics of suicide are
very high among hikikomori sufferers. Finally, the core “hiding” feature of
hikikomori does not necessarily involve a complete breakdown of the willingness
to interact because of fears of shame or being criticized. I think these have
often been experienced previously but are now not central themes and so, in
this way “hikikomori” could be seen as an end game or aftermath of such
feelings; an attitude closer to apathy
than panic BUT not apathy and most certainly not panic.

Acute Social Withdrawal.

This is most commonly a secondary symptom in pscyciatric
terms.

It arises out of specific triggers which are most commonly:

·Depression

·Bi-polar

·AIDS or other serious illness diagnosis

·Seasonal Affective Disorder

·Dementia

·Schizophrenia or other schizoid affective
disorder

·Autism

In all these cases symptoms are resolved when the primary
trigger is resolved or addressed.

None of these primary triggers moreover address the NON
COMMUNICATING (refusal or extreme

reluctance to open up and talk) aspect and deep central
theme in ALL cases of hikikomori.

In other words, being able to identify the primary cause
allows a treatment plan to be more easily

mapped than
hikikomori where so many unknowns and variables are inexplicable because they remain unexplained.

Agorophobia.

Here is a definition of agoraphobia from Forsyth, Sondra.
"I Panic When I'm Alone." Mademoiselle April 1998: 119-24.

Agoraphobia is just one type of
phobia, or irrational fear. People with phobias feel dread or panic when they
face certain objects, situations, or activities. People with agoraphobia
frequently also experience panic attacks, but panic attacks, or panic disorder,
are not a requirement for a diagnosis of agoraphobia. The defining feature of
agoraphobia is anxiety about being in places from which escape might be
embarrasing or difficult, or in which help might be unavailable. The person
suffering from agoraphobia usually avoids the anxiety-provoking situation and
may become totally housebound.

Agoraphobia is the most common type
of phobia, and it is estimated to affect between 5-12% of Americans within
their lifetime. Agoraphobia is twice as common in women as in men and usually
strikes between the ages of 15-35.

It is clear from this definition that agoraphobia, often
also called Acute social withdrawal, usually involves panic attacks as a core
symptom, but not always; and always involves anxiety attack or extreme anxiety
as a psychiatric disorder that hikikomori adolescents, children and adults do
not in the majority do not suffer from as a primary symptom ( ).

Conclusion

In this paper, I have looked at what I believe to be just 5
of the main differences in the symptom of Japanese hikikomori versus the definition
of hikikomori and or its synonyms in other countries. There is clearly much
more to research and much more to be discussed, including a far wider range of
research involving a wider selection of countries and cases. However, I hope
that this brief introduction to five of the areas I think need further
investigation will provide a platform for further research into my hypothesis
that hikikomori is without doubt, a Japanese culture reactive or culture bound
syndrome, not to be seen as simply withdrawal and retreat by an individual with
a mental health issue, but instead an expression of how the system of education
in Japan and expectations in society need to change before we can come closer
to reducing hikikomori numbers and ending the immense suffering for hikikomri
people and all those families who have been and continue to be prisoners to the
powerful destruction of life in the shadow of hikikomori.

Tuesday, 15 April 2014

1.AISATSU:It is drilled into children from a very
young age to say good-morning, good-afternoon and good evening on absolutely
every single encounter with anybody in your life and also strangers that pass
through your living/workingarea BUT not
out and about on hikes etc. If these words are not exchanged, a following
encounter with the person may be strained. Posters at schools everywhere and
banners in school playgrounds read “Don’t forget your daily greetings”.A teacher or two will man the gates of
schools, elementary through high school, every morning and every single child
entering the gate is expected to say in a clear polite voice, their morning
greeting. A tremendous amount of kudos and respect is given to ( and kept score
of)those students or members of society who never fail to forget to
appropriately greet with the accompanying slight head bow at all times, to all
members oftheir group.

This is the OPPOSITE from expectations in the UK, USA etc. where we may pass a
stranger out hiking and greet them but
where it is often considered uneccessary,
too formalor just strange to say these wordswithin the family or one’s close circle of
friends.